New forecasts reveal that 39 million deaths will be directly attributable to bacterial antimicrobial resistance (AMR) between 2025-2050

Based on estimates across 204 countries and territories, new forecasts from the Global Research on Antimicrobial Resistance (GRAM) Project suggest that bacterial antimicrobial resistance (AMR) will cause 39 million deaths between 2025 and 2050 – which equates to three deaths every minute. 

Published in The Lancet, Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 provides the most comprehensive analysis of bacterial AMR trends over time. For the first time, GRAM, funded by Wellcome and the United Kingdom Department of Health and Social Care’s Fleming Fund, also forecasts these trends to provide future estimates of global AMR deaths from now until 2050, to provide policymakers with evidence to support data-driven decisions to address AMR.

The study forecasts a 67.5% increase in annual deaths directly attributed to bacterial AMR, rising from 1.14 million in 2021 to an estimated 1.91 million in 2050. Deaths associated with AMR are also expected to increase by 74.5%, from 4.71 million in 2021, to 8.22 million deaths in 2050.

AMR is a major global health threat

Bacterial antimicrobial resistance (AMR) occurs when bacteria change in a way that makes them no longer respond to medicines. As such, people die from common infections such as pneumonia, urinary tract infections, and diarrhoea because bacteria have become resistant to treatment. 

The estimates suggest bacterial AMR remains a constant and growing global health threat, with over a million lives lost each year since 1990 – a total of more than 36 million deaths. Among the different types of antibiotic-resistant infections, methicillin-resistant Staphylococcus aureus (MRSA) was responsible for the largest increase in deaths between 1990 and 2021. Deaths from MRSA more than doubled over this period. 

The paper was published ahead of the UN General Assembly (UNGA) High Level Meeting (HLM) on AMR later this month, which will bring global leaders together to discuss the impact of AMR on global health and economies, and to agree collective action.

Dr. Christopher J.L Murray, Director of the Institute for Health Metrics Evaluation and lead for the GRAM study explains: “New estimates indicate that AMR has always been, and remains, an urgent global health threat. With projections showing over 39 million deaths directly attributable to bacterial antimicrobial resistance from 2025-2050, we can better understand this the impact of this burden. By utilizing estimates provided in the GRAM report, policymakers can leverage data-driven decision making to effectively tackle this crisis.”

New estimates suggest that current trends are unsustainable 

Notably, for the first time, GRAM estimates show that that AMR poses the biggest threat to older adults, as deaths in adults aged 70 and older increased by more than 80% between 1990 and 2021. This suggests that the threat of AMR is set to grow even further over time due to rapidly ageing populations that are more vulnerable to infection. 

Dr. Timothy Jinks, Head of Interventions in Wellcome’s Infectious Disease team comments: “While there has been some progress tackling AMR in recent years, it isn’t enough and more needs to be done. The GRAM estimates are an important tool in the fight against AMR, and we hope that global policymakers utilise the paper’s findings to make evidence-based decisions, supporting the development and implementation of impactful National Action Plans. By doing so, the implementation of bold action on AMR can strengthen health systems and protect the world’s most vulnerable from infectious disease.” 

Without decisive action, which requires increased financing to facilitate the implementation of National Action Plans (NAPs), AMR will continue to afflict communities worldwide – especially those in low- and middle-income countries. 

The latest GRAM estimates suggest that low- and middle-income countries face a disproportionate burden. Sub-Saharan Africa and South Asia account for the highest rates of attributable and associated AMR deaths, with a particularly high number of deaths from multi-drug resistant (MDR) tuberculosis.  

As well as causing death, AMR puts strain on vulnerable health systems and national economies, creating the need for more expensive and intensive care, and contributing to a GDP loss of $1-3.4 trillion per year by 2030.  

Dame Sally Davies, the UK Special Envoy on Antimicrobial Resistance said: “This landmark study confirms that the world is facing an antibiotic emergency, with devastating human costs for families and communities across the world. It substantiates our calls to all sectors to take decisive action now to save lives and save modern medicine for generations to come, and address the needs of low-and-middle income countries who bear the greatest tragedies from AMR. Next week's High-Level Meeting is a crucial milestone for global leaders to commit to political action on AMR, and afterwards, we all need to work together to move forward.”

Since 1990, AMR deaths among children under 5 have declined rapidly, from 488,000 in 1990 to 193,000 in 2021. The study suggests this is owed to successes in reducing the incidence of serious childhood infections, such as through vaccination programmes including the roll-out of pneumococcal conjugate vaccines (PCV) and improved access to drinking water, sanitation and hygiene (WASH), and not by a reduction in the prevalence of AMR. 

Global leaders must use upcoming political moments to leverage evidence and take decisive action to protect people around the world from the threat of AMR 

The forecasts also consider the potential impact of interventions on AMR deaths. The study   suggests investments in healthcare to deliver improved care for severe infections and access to antimicrobials could save up to 92 million lives by 2050, while the regular release of new antimicrobials that target Gram-negative pathogens could avert up to 11 million AMR-related deaths. 

The paper therefore identifies the following solutions that can drive progress against AMR: 

1. Accelerate prevention and control measures, expanding access to new antibiotics and vaccines, clean water, and sanitation – whilst raising public awareness about the dangers of AMR. 
2. Improve the quality of health care in hospitals and health centres, namely enhancing diagnostic capacity, training a more robust healthcare workforce, implementing infection prevention and control measures, and expanding the availability of lifesaving technological interventions for people with advanced disease.  
3. Governments and the private sector must develop incentives and increase funding at every stage of the development pipeline for new antibiotics targeting drug-resistant bacteria such as E.coli and K.pneumoniae, and ensure that these medicines reach the people who need them most.  
4. Work to address the impact of AMR on the health of people and animals, by prioritizing international collaboration in research, surveillance and public health initiatives using a One Health approach.  

While action on AMR happens locally – primarily in health systems as well as in communities – urgent action from global leaders is needed to help secure faster progress and greater global impact. Ahead of upcoming political moments, GRAM partners call on global leaders and healthcare professionals to leverage this new evidence to correct the trajectory and take decisive action to protect people around the world from the growing threat of AMR.

About GRAM

The Global Research on Antimicrobial Resistance (GRAM) Project is the flagship project of the University of Oxford–IHME Strategic Partnership, funded by the United Kingdom Department of Health and Social Care’s Fleming Fund and Wellcome.

In 2022, the GRAM Project published the first ever data set on the burden of AMR deaths – revealing unprecedented insights into the true scale of this global health threat. Policymakers can use GRAM estimates and trends over time to make evidence-based decisions, supporting the development and implementation of tailored National Action Plans.